TB 'out of control' in SA
2006-08-21 10:40
Lindsay Barnes and Health-e News
Durban - The South African government must immediately declare TB and TB/HIV a national emergency and increase dramatically the intensity of its response to what is one of the worst epidemics in the world, the World Health Organisation said.
The Medical Research Council (MRC) told the Weekend Witness that South Africa is in danger of an uncontrollable tuberculosis epidemic because the government's inadequate control of patients defaulting on treatment is leading to a rapid rise in resistance to TB drug treatment.
A frightening new strain called extreme drug resistant TB has emerged in all provinces in South Africa in the past few years and as there are no drugs to treat it the only outcome of this form of TB is death, said Dr Karin Weyer, MRC operational and policy research head.
The government is directly responsible for the rise in these drug resistant strains of TB as resistance develops when patients fail to complete the treatment course, an indication that the management of patients at state health facilities is poor.
High drop-out rate
In South Africa, about 25% of TB patients currently drop out of treatment or move to another province without transferring to another TB treatment programme, according to the Health Department's national TB crisis management plan.
The WHO called for the government to reduce patient default and transfer out rates to less than 10%.
This drop-out rate is highly problematic. Multi-drug resistant TB (MDR-TB) has developed from people with active TB not completing their medical treatment course.
Extreme drug resistant TB (XDR-TB) has developed from people with multi-drug resistance defaulting on treatment.
Research published by the Medical Research Council in June shows that around 70% of patients with MDR-TB don't complete treatment and death among MDR-TB patients is high.
Ironically, one of the main reasons that people fail to complete the course is poor treatment by the nursing staff, the MRC's research has shown. TB patients are shouted at and blamed for not arriving for treatment and this attitude needs to change, Weyer said.
SA as low cure rate
"No attention is being given (by the government's health facilities) to patients who default on treatment," she said.
Health staff are required to visit defaulters to encourage them to continue the treatment but staff complain of staff shortages and transport problems. The drop-out rate is compounded by treatment for MDR taking two years and making patients feel ill.
"After 25 years working in TB treatment, I am extremely concerned. We see very little progress and there seems to be complacency in general about TB," she said.
"The WHO is not aware of any specific plan yet available to face such an epidemic," the organisation said in a statement.
When asked why the health department had not declared TB an emergency, spokesperson Sibani Mngadi said the department has declared it a crisis and has developed the national TB crisis management plan which covers all the areas that the WHO-Afro member states committed themselves to last year.
The department has allocated an extra R36 million to implement the plan in line with these resolutions, he said.
South Africa has a low TB cure rate of 50%, which falls far short of the WHO's required rate of 85%.